Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia.

The article identified challenges that Georgia physicians encounter. Particularly concerning is Georgia’s poor performance regarding the health of the state’s residents and physician burnout levels. Both issues could be ameliorated via full Medicaid expansion.

It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse.

Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million.

Without the ability to see a doctor regularly, chronic conditions worsen, and morbidity increases. We see this progression every day in our practice; this leaves us with the arduous task of addressing complex medical conditions in a state that makes necessary care inaccessible for so many.

Participating in this struggle for our patients’ lives often leads to moral fatigue, workplace stress, and burnout for medical providers. It’s one of the primary reasons that Georgia is not retaining more of its physician trainees.

The student-led non-profit organization Health Students Taking Action Together (H-STAT) conducted a study this spring about the perspectives of medical trainees regarding their clinical experience in our state. Among other findings:

a. 81 percent of respondents felt most Georgia residents do not have access to quality medical care,

b. 80 percent believe that our high uninsurance rate contributes to physician burnout, and

c. 60 percent would be more likely to stay in our state if options for better access to insurance coverage were available.

It is clear, then, that Medicaid expansion is not only good for patients but also for their doctors. And that increased insurance coverage would improve Georgia’s healthcare practice score.

It is limiting to think of our state as little more than a number in a ranking system. The Medscape analysis fails to consider Georgia’s growing economy, diverse patient populations, kind people, and other remarkable aspects that drew us to and kept us here. However, the study does point out that we have significant work to do to make our state a more appealing place to practice. That effort must start with full Medicaid expansion.

Brendan Pulsifer is a medical student. Surabhi Beriwal is an ophthalmology resident. Tracey L. Henry is a primary care physician. Toby Terwilliger is a hospitalist. Jack Bernard is chair, Fayette County Board of Health.